Hypotensive episodes revealed by ambulatory blood pressure monitoring in nursing home residents

In this sample of NH residents undergoing ABPM, hypotensive episodes were highly prevalent (55%) and related with a specific ABPM profile including lower mean BP values, reverse dipping, and white coat effect. This profile suggests that a certain degree of autonomic dysfunction may be present as a consequence of cardiovascular aging and comorbidities, leading to higher BP during the night-time and orthostatic/postprandial hypotension during the daytime. Second, overtreatment may contribute to hypotensive episodes, as white coat effect may determine excessive BP lowering in residents presenting with high office BP. Hypotensive episodes were independently associated with benzodiazepines, consistently with previous studies describing a hypotensive effect of this class. An independent association with digoxin was also observed, which may be related to comorbidities such as heart failure and atrial fibrillation. Finally, our study revealed an independent association between hypotensive episodes and low serum creatinine, which is common in older adults with sarcopenia.